EGFR+ Advanced NSCLC: Molecular Testing in Patients Resistant to Frontline TKIs

EP: 1.Regional Recommendations and Approaches to Biomarker Testing in NSCLC

EP: 2.Considerations for Biomarker Testing in NSCLC: Gene Panel Size and Reimbursement

EP: 3.How Has Biomarker Testing Impacted Clinical Practice Across Geographic Regions?

EP: 4.Biomarkers for Guiding Treatment in NSCLC: Liquid Biopsy Versus Tissue-Based Testing

EP: 5.Treatment Strategies for Resectable NSCLC in Asia, With a Focus on Stage IB Disease

EP: 6.Is There a Role for Postoperative Radiotherapy in Stage III NSCLC?

EP: 7.The ADAURA Trial: Adjuvant Osimertinib in EGFR+ Resectable NSCLC

EP: 8.Is There a Continued Role for First-Generation TKIs in Resectable NSCLC?

EP: 9.Global Perspectives on Routine Molecular Testing in Postoperative NSCLC

EP: 10.Resectable NSCLC: Is There a Role for Multidisciplinary Care and Neoadjuvant Therapy?

EP: 11.Regional Approaches to Frontline Treatment for EGFR+ Advanced NSCLC

EP: 12.EGFR+ Advanced NSCLC: Review of Bevacizumab-Based Combination Therapy

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EP: 13.EGFR+ Advanced NSCLC: Molecular Testing in Patients Resistant to Frontline TKIs

EP: 14.EGFR+ Advanced NSCLC Resistant to Frontline TKIs: Small Cell Transformation and MET Amplification

EP: 15.EGFR+ Advanced NSCLC Resistant to Frontline TKIs: C797S Mutation

EP: 16.Future Perspectives in EGFR+ NSCLC

Transcript:

Tony S.K. Mok, MD: Now we have already talked about a few different combinations of chemotherapy with bevacizumab. Let’s move into resistancy. Let’s first talk about the testing for resistancy. Patients with first-generation [disease], it’s easy to just go for the T790M IL [interleukin] testing, but what about osimertinib first-line failure? What would be your routine testing on a patient who failed osimertinib? Tetsuya?

Tetsuya Mitsudomi, MD, PhD: In Japan, without the research purposes, we do not do the testing after the osimertinib area.

Tony S.K. Mok, MD: In China, Lu Shun?

Shun Lu, MD, PhD: [In clinical] practice, we are not routinely using the NGS2 [next-generation sequencing] test of EGFR resistance. Still we select the patients to test based on the c-MET high verification. Right now, we have MET TKI [tyrosine kinase inhibitor]. We will select the patient to use in the combination. Although there are no randomized phase 3 studies to show the positive results, but still there are some patients who don’t like receiving the chemotherapy or something. Or even after the chemotherapy we will use this.

Tony S.K. Mok, MD: OK, and Yi-Long, would you do routine testing of the osimertinib resistance?

Yi-Long Wu, MD, PhD: In clinical practice generally we don’t give the recommendation for the test of osimertinib resistance using NGS or [INAUDIBLE], but in my clinical practice, almost 80% of patients receive liquid biopsy. To test that they use NGS. I want to know what is the mechanism for the osimertinib resistance. So in my patients we are looking to divide the patient to the on target resistant, or the off target resistant, or the translocate the small cell lung cancer. Because this is different—the mechanism—we have the different treatment strategies. So in clinical practice a routine test, the osimertinib [is given] for the failure patient.

Tony S.K. Mok, MD: Myung-Ju, in Korea?

Myung-Ju Ahn, MD: Even though osimertinib is not reimbursed as a first-line [treatment] in a patient who received the osimertinib as a first line and then progress, I do routinely do the repeat biopsy because 10% to 15% of patients have their histological transformation, like small cell and squamous. So that’s 1 reason. The other reason is that it encourages the patient to participate in clinical trials. So I do the NGS [testing], yes.

Transcript edited for clarity.